COLUMBUS, Ohio -- The Ohio hospital system where excessive painkiller doses were given to dozens of patients who died fired 23 nurses, pharmacists and managers Thursday and said it is changing leadership, a sign that professional fallout from the scandal has expanded far beyond the intensive care doctor accused of ordering the drugs.

The announcement by the Columbus-area Mount Carmel Health System comes five weeks after that doctor, William Husel, pleaded not guilty to murder charges in 25 of the deaths, marking one of the biggest cases of its kind against an American health care professional.

The newly fired employees include five physician, nursing and pharmacy management team members, President and CEO Ed Lamb said in a statement.

Mount Carmel said the other 18 fired were among the nurses and pharmacists who had been on administrative leave during its internal review.

One employee remains on administrative leave, and 11 are being given the chance to return to work if they complete additional training, Lamb said. Mount Carmel didn't specify whether those employees are nurses and pharmacists who administered or approved the excessive doses.

Authorities have said the nurses and pharmacists involved aren't being prosecuted, though dozens have been reported to their respective professional boards for review and potential disciplinary action.

Lamb also said that he is resigning this month and that Mount Carmel's chief clinical officer is retiring in September, paving the way for new leadership that could "facilitate healing and help restore the trust of the community."

Mount Carmel fired Husel in December and concluded he had ordered potentially fatal doses for 29 patients who died over the past few years.

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